Generic weight loss medicines will place new demands on the NHS

The conversation around weight loss is increasingly shifting from personal health to national economic strategy. The idea of “shrinking ourselves” to expand the UK economy is gaining traction, and weight loss medicines are at the forefront of this discussion.

Just recently, both prime minister Sir Keir Starmer and health and social care secretary Wes Streeting spoke about the impact these medicines could have on obesity levels and the resultant burden that places on the NHS.

Indeed, the government has signed a deal for the first “real-world study” into the effectiveness of a weight loss drug in helping the job prospects of people living with obesity in Greater Manchester.

The facts are stark. People unable to work because of long-term sickness are at record levels and weight loss medicines could prove to be a key tool in getting Britain fighting fit economically. A fiscal necessity, given The Tony Blair Institute estimates obesity costs UK society £98bn.

Therefore, news that the first generic versions of weight loss medicines are available this month, following the patent end of Liraglutide branded products Victoza and Saxenda, is momentous. Generics – as they are more affordable – offer the opportunity to make medicines more available, thereby reducing inequalities.

Such has been the popularity of patented products such as Mounjaro, demand has often outstripped supply. A sizeable private prescription market has been established, meaning the NHS has struggled to access medicines to prescribe to diabetes patients. Generics may be part of the solution.

The typical hallmarks of generic competition are significant cost savings to the NHS and increased supply due to the plurality of manufacturers competing for market share on price. At least four companies are expected to have UK marketing authorisations with indications to cover type 2 diabetes and obesity.

However, Liraglutide may not follow the normal market dynamics of a loss of exclusivity event, at least not initially. Several factors are at play.

Unlike most medicines prescribed on the NHS, there is already a significant market in private weight loss prescriptions, whether available in high street or online pharmacies. As a result, it is difficult to determine precisely what unmet need there currently is. However, crucially, generic medicines should help make these medicines more available to all who need them, not just those who can afford them.

The government and the NHS need to be clear that these medicines are part of a broader focus on improved diet and increased exercise

Another factor is the availability of alternative patented branded products such as Mounjaro and Wegovy (also known as Ozempic, prescribed for type 2 diabetes), which require once-a-week jabs compared to daily injections with Liraglutide. Some patients may prefer the once-weekly injections, while others may be agnostic if generic Liraglutide’s price point is more affordable. Mounjaro and Wegovy will lose patent protection in 2032 and 2028, respectively.

These considerations will mean that uptake could be hard to track at first. However, what is clear is that competing off-patent versions will bring greater capacity and choice, allowing the NHS to start treating increased numbers of patients for weight loss and type 2 diabetes with the broader long-term benefits that can deliver. Indeed, there were shortages of Saxenda and Victoza for a year before patent expiry, and so generic versions will provide more market capacity and resilience.

However, these medicines should not be seen as a panacea for the obesity crisis. If used effectively, they can make a significant difference, but as an association, we believe certain safeguards must be in place.

For example, weight loss medicines need to be prescription-based and not available as an over-the-counter product. This should be the case whether they are obtained privately through a high street pharmacy or a solely online pharmacy, for example, or prescribed via the NHS. We urge those selling the medicines to ensure that patients have regular GP consultations and can report any concerns.

Additionally, the government and the NHS need to be clear that these medicines are part of a broader focus on improved diet and increased exercise – taking account of a range of complex issues from individual patient needs to the food industry. The medicines alone will not deliver lasting and sustainable weight loss. For these medicines to deliver not only patient benefits but reduce need from the broader healthcare system, support must be put in place to help patients use them as part of other changes to their lifestyles. Public health needs the resources to deliver this.

Elsewhere, the delivery of the NHS service is likely to create more GP consultations and administration, which will need planning and support. We expect the increasing use of these treatments to reduce GP and acute NHS workload and resources in due course.

Finally, with multiple weight loss treatments likely to be available at different price points, the NHS will need to implement updated prescriber guidance following Liraglutide’s loss of exclusivity. This should set out treatment prioritisation for different patient cohorts and ensure that NHS funds are used cost-effectively. Local consistency around prescribing should be encouraged to reduce postcode inequalities.

The genericisation of the first wave of weight loss medicines is undoubtedly a significant development for the NHS and societal healthcare more broadly in the UK. These products can deliver essential public health benefits, access to medicines, NHS cost savings and broader knock-on benefits – provided policymakers see these medicines in the context of other factors, such as tackling the issues regarding unhealthy foods and sedentary lifestyles.

The hope is that weight loss medicines can help more Britons to live healthier in the long term, increasing productivity and saving the billions that obesity costs the NHS annually.

However, they are not a magic bullet and must be used alongside the required policy changes, such as addressing the obesogenic environment. Only then can the shedding of pounds become a meaningful part of the solution to creating pounds sterling – through improved productivity – for the nation’s coffers.